Geria reviewer
COMMUNITY RESOURCES FOR CARE OF OLDER
PERSONS
Community Resources
• Caregiver associations and support groups.
− These are the daycare services for senior ([In
Manila] PDN – private duty nurses – should be
registered and qualified to be a PDN)
− In Zamboanga, there are agencies where we can
hire caregivers to take care of the older adults
− Best contact person are the doctors because they
are the one who refer the patient for caregivers
• Hospice and palliative care programs.
− Hospice is a type of health care that focuses on the
palliation of a terminally ill patient’s pian and
symptoms and attending to their emotional and
spiritual needs at the end of life.
− Hospice care priority is providing comfort and quality
of life by reducing the pain and suffering.
− Palliative care is treatment, care, and support for
people with a life-limiting illnesses (ex. 6 months to
live)
− Both: provides comfort, but palliative care can
begin at diagnosis at the same time treatment,
while hospice care begins after the treatment of
the disease and it is stopped when it is clear that
the person will not going to survive the illness.
• Disease-specific support groups and associations
Goals of Community Resources--------------------------------------
• Providing quality health and long-term care
• Ensuring, enabling and supportive environment
− Integrated network of community support for the
able-bodied senior
− Managing of older persons with Alzheimer’s
Disease (AD)
▪ The number of dementic pt are growing – they
have ID and medic alert bracelet so that when
we meet this people we will know because there
is a serial number and all information that are
needed to be seen/ known to that particular
patient
− Challenges: Issues and gaps----------------------------
▪ Rising number of senior citizens who are
victims of violence abandonment
- Violence against women and children (need to
be report)
▪ Noncompliance of some residential buildings
and establishments in terms of making their
facilities accessible to senior citizens
• Community health clinics
− Barangay health centers in our community should be
accessible to our older people. But unfortunately, not
every day we have available doctors
• Geriatric case management
− This provides coordination of care and community
resource referrals either through a public agency
such as council on aging or through entrepreneurial
agency.
pg. 1 – SHANE SANTOS
Criteria for Evaluation
Indicators for Wellness
Physical wellness Environmental well.
Psychological/emotional Cultural wellness
well. Climate wellness
Social wellness Governance and social
Intellectual wellness justice wellness
Spiritual wellness
Responses of care
- We have to evaluate how our lola and lolo response to the
care they received otherwise we may not know if they are
receiving is effective or not. (Usually, may mga favorite sila or
may gusto sila sa care na nabibigay sa kanila, need to
evaluate)
Standards and Criteria of Gerontologic Nursing fd
1. Uniqueness of older people
2. Functional ability and independence. The ability to
function and maintain independence is significant for
older persons. (– to optimize their functions)
3. Mastery of the environment. A sense of mastery over
the environment (or life situation) is essential for older
adults.
- Ryff and Keyes defined mastery as the capacity to
manage effectively one’s life and surrounding world while
Strauser, Lustig, and Ciftci 2002 viewed it as an
individual’s ability to choose and create environments
that meet his or her specific needs. (– that is why we have
this independent living and assisted living so that elderly
can chose whether to live in an environment where they
wanted to be in a same group that they have)
4. Gerontological Nursing Knowledge. This practice is
derived form a specific and evolving body of knowledge
pertaining to older persons.
5. Sustaining interpersonal relationship. The
development of sustaining interpersonal relationships
(relationship with other people/ how we deal) facilities
older to cope with their health care experiences.
6. Advocacy. Gerontological nurses should advocate with
older persons and on behalf of older persons to protect
their rights, responsibilities and dignity. Advocacy we
mean support or recommend. (- [1] maximizing their
independent activities (hygiene), advocating those right
of the pt will not limit their rehabilitative/ aspect of the pt.
– [2] Promote their right for autonomy, let them choose
their path of care, ex daily activities (like ano ang una
nilang gusting gawin), in those simple acts we can be an
advocate of autonomy to which some older people feels
that natatake away yun sa kanila kase most of their
families do the taking for them, so wala nang choice yung
elderly. With this mapapafeel natin sa pt naming na they
are still part ng care nila.)
In psych setting we cannot call them in such title (lola, lola) –
for professionalism, we form boundaries to therapeutic
relationship.
Geria reviewer
Ethical Aspects in the Care of Older Persons work. And this includes respect for
What is ethics?
privacy and maintaining
Philosophical science dealing with morality of human conduct confidentiality. There is so much
or action. It is our moral principle that governs or what we values that needs to be placed on
consider before we conduct certain activity actually, the branch the concept of confidentiality that
of knowledge that deals with moral principles. is considered a right --- the right to
privacy.
Nursing Ethics. Concerned with moral principles that govern Fidelity
the conduct of a nurse in his/her relationship with patients’ Refers to keeping promises or
physicians, colleagues, the nursing profession, and the being true to another; being
community or public. faithful to commitments and
• The ethics of care in the geriatric population includes responsibilities. Fidelity is
compassion, equality, fairness, dignity, particularly important in the care
confidentiality, mindfulness of a person’s of geriatric patient because of the
autonomy within the realm of the person’s abilities
amount of trust our lolo and lola
and mental capacity.
• Ethical concepts are principles that facilitate decision put in the health care system.
making and guide our professional behavior. Usually, Fidelity is not only important to
they came from our own beliefs and values, religion and patient, but also important in
culture and family expectations. Also, this is driven by relationships with the organization
moral reasoning – our determination of what is right and where we works and with co-
wrong.
workers. Sabi nga trust is earned
• Ethical concepts and personal values usually define
our character and are expressed in our conduct and and fidelity is demonstrated in
actions. This is the basic reasons why there are daily work.
professional codes or standards within the profession Fiduciary It is necessary that all nurses
of nursing to help define ethical actions. We, nurses responsibility should understand the cost and
must have a clear understanding of our own values and benefits of care that is given.
strategy for decision making when it comes to patient Nurse has ethical obligation to
care because personal beliefs may be quite different
good stewardship of both the
from the patients, from the organization’s values and
expectation or even from the community’s public rules. patient’s and the organization’s
fund where you are working. This
What principles make actions morally right? fiduciary responsibility refers to
Advocacy Refers to loyalty and a using both fiscal reserves (refers
championing of the needs and to the government day to day cash
interest of others requiring the flow needs or parang fund
nurse to educate patients and intended for certain coverage) and
their families so that they know caregiving resources wisely.
Justice Fairness
their rights are fully informed, and
that they are able to access all the Quality of life Right to life/ live
benefits they are entitled to. Reciprocity This is a feature of integrity
Also refers to maintaining the concerned with the ability to be
status of care, we should be true to one’s self while respecting
committed to the well-being of the and supporting the values and
patient so we must take views of another. This is very
appropriate action if we can see important especially when we deal
that there are incompetent, illegal, with patient that has different
unethical or impaired practice that values and views with ours. We
puts a patient at risk. We are have to be impartial or not biased
obliged to address the issue with once a plan of care is already
the person involved and if there is been agreed upon. We have to
a need to bring it to higher respect kahit na iba sya sa
authority so that the patient will not paniniwala natin. According to the
be placed in jeopardy. book, if a nurse or other health
Autonomy Concept that person has a right. care provider cannot demonstrate
Beneficence/ Doing good and doing no harm. reciprocity, another should take
non his of her place in the care of the
maleficence patients.
Confidentialit The code of ethics emphasized
y Sanity of life
respect for human dignity which Veracity Means truthfulness and refers to
can be demonstrated in daily telling, or deceiving patient or their
pg. 2 – SHANE SANTOS
Geria reviewer
families. This is very important
especially when it comes to
informed consent, we really have
to tell the truth and have to explain
very well the options, so that the
patient can possibly make the
best choice. Dilemma here, do
you tell the truth when you know
that it will cause harm or distress?
How do you maintain hope while
sharing a poor prognosis?
ANSWER: It is possible to support
hopefulness and decrease stress
with truthfulness through careful
choices of words. Ex. “It will take
considerable work and fortunate
healing of your brain in order for
you to walk again., but we will
work with you and see what
happens.’ Instead of telling “you
will not likely to walk again
considering the severity of the
stroke.
Current Trends & Issues in the Care of the Older Person
• Trend in Long Term-Care: “the broad range of medical,
custodial, social and other care services that assist
people who have impaired ability to live independently
for an extended period.”
o Geriatric Care Management
▪ Professional Geriatric Care
Management (PGCM) is a specialist who
helps families care for older adults while
encouraging as much independence as
possible
▪ PGCM may perform the following services:
• Conduct assessments
• Develop care plans that address
pertinent problems
• Arrange, interview for and monitor in-
home caregivers or other services
• Acts a consultant for caregivers
• Review financial, health-related, legal
issues
• Provide referrals to other geriatric
specialists
• Intervene in times of crisis
• Act as an advocate and/or liaison
between families and service providers
• Keep the family informed of any
problems
• Coordinate or oversee care
• Assist with transitions in living
arrangements
• Provide education and links to
resources
• Offer counseling (active listeners; may
suggest but don’t advice) and support
• Some PGCMs offer guardianship,
caregiving
pg. 3 – SHANE SANTOS
Hospice Palliative Care
Hospice (Terminally ill – span not more than 6 months)
• Is a way of caring for the terminally ill and their families,
it aids in putting quality and meaning into the remaining
period of life
• A house of rest and entertainment for destitute or the
sick. A patient receiving hospice is no longer receiving
curative treatment. This is because maybe the family
and the doctors already recognize that such treatment
is no longer effective and that it may actually be
causing the patient pain and discomfort.
• Hospice Facility – provides a homelike, non-
institutional atmosphere. It aids in putting quality care
and meaning into the remaining quality of life of the
client. The family members are encouraged to
participate in the patient’s care.
• The hospice teacher family members how to give
medication, and other practical aspects of care. (Filial
care)
Primary Goal of Hospice Care
• So, unlike other medical care, the focus of the hospice
is not to cure the underlying disease. The goal is to
support the highest quality of life possible for whatever
time remains.
− Provide comfort
▪ Mainly the purpose of hospice. If pain and
other distressing symptoms of the patient of
the older person condition are not being
addressed, then it is impossible for the patient
to achieve any of their goals. This is usually
given emphasis above all other goals in
hospice. – Achieving this goal, we have to
provide medication therapy management like
non-opioids like aspiring and paracetamol,
them mild opioids like codeine, then strong
opioids such as morphine. Other therapist like
massage, gentle exercises and anything else
that helps the patient cope with his/her
condition.
− Relieve physical, emotional and spiritual
suffering
▪ Older people diagnosed with terminal illness
must deal with mobility issues and other
symptoms that may make everyday task
difficult, it is very important that we provide
them assistance from bathing and haircuts to
eating and dressing. These services will help
them feel more like themselves and more in
control of their situation. And, regardless of
religion, spiritual faith can be a great source of
comfort to patient and caregiver as well. It is
important to recognize the value of belief in a
higher power.
− Promote the dignity of terminally ill persons
▪ Patient receiving hospice still have many
choices to make about the care they receive,
so we have to include the patient especially if
they are still able like healthcare directives.
These directives will make the patient’s wishes
known to health care provider and family
members in the event of a medical crisis.
Although this may be not pleasant to think
about, but sometimes some people draw
comfort from knowing that their wishes will be
Geria reviewer
honored and that this can promote their
dignity.
Hospice Philosophy
• Emphasizes the belief that patients should be as
comfortable as possible during the latter days of their
illness
• Is the interdisciplinary team approach that looks for
solutions to the patient’s medical, psychosocial and
spiritual problems and helps patient die with dignity
▪ Pain relief
▪ Symptom control
– treat the symptoms of the disease not the
disease itself.
- to maximize the person’s quality of life by
effective symptom control, psychological, and
spiritual support in a socially meaningful way
while truly allowing patient or that someone to
be themselves at a difficult time.
▪ Coordinate home care and institutional care
▪ Bereavement follow-up and counselling
Palliative Care
• Approach that improves quality of life of patients and
their families feeling the problems associated with
life- threatening illness through prevention and relief
of suffering by means of early identification and
impeccable assessment and treatment of pain and
other problems, physical, psychological and spiritual
(WHO, 2002)
• According to WHO, Palliative Care begins at
diagnosis and at the same time the treatment
Principles of Palliative Care
• Provides relief from pin and other distressing
symptoms
• Affirms life and regards dying as a normal process
(everybody will be coming to an end, we have to
assist the client in terms of anticipated grieving
process, because they have to grieve, otherwise this
will not/ there would be no resolution of the upcoming
laws if there would be no aggrievement.)
• Intends neither to hasten nor postpone death
• Integrates the psychosocial and spiritual aspects of
patient care
• Offers a support system to help patients to live as
actively as possible until death
• Offers a support system to help the family cope
during the patient illness and in their own
bereavement
• Palliative care is not simply a process that a patient
undergoes in hospital by themselves. It’s a
philosophy that is integrated into their overall care
and the care their family receives
Support System During Patient’s Illness
• Safe and effective care environment
• Health promotion and maintenance
• Psychosocial integrity
– along with physiological integrity is a basic health
need for all patients.
- we have to provide and direct our nursing care that
will promotes and supports the emotional, mental and
social wellbeing of the patient or client experiencing
stressful events. The psychosocial care consists of
providing holistic care, spiritual care, counselling and
support to the patient and family members and showing
our empathy. Therefore, good communication with the
pg. 4 – SHANE SANTOS
patient as well as with the family is very essential.
• Physiological Integrity – basically here in physiological
integrity, the nurse should provide care and comfort.
• We can’t cry with our clients – excuse ourselves – doctors
are behind the feelings of the clients but nurses are up
on the feeling of the client – we can offer tissue paper
and water (not handkerchief)
• Don’t stop them from crying because the moment we stop
then, hindi na sila makakapag vent out ng kanilang
emotions – let them release tention that they have –
wait until they stop before talking to them
• Use empathy not sympathy – you don’t advice (non-
therapeutic technique) but we can suggest, listen,
counsel, options, encourage, assist – word why, nganu
man, bakit, mayta, porque is non-therapeutic because
why entails explanation, the client is not a position to
explain but we explain as nurses (everything we do),
instead ask what do you feel? Can you tell me more
about that?
• Very good, that’s bad – non-therapeutic, just acknowledge
• Call them with their title not lola, lolo
Essential Components of Palliative Care
• Effective symptoms control – this is to prevent or
treat as early as possible the symptoms of the
disease that will come
• Effective communication with patient and
families – should be based upon patient’s
underlying knowledge about his/her condition and
should be focused on addressing his/her direct
questions, if he/she is till in denial, and/or anger
stage, good communication is important because
this can help to ensure that the dying person’s
expressed wishes are considered and this can avoid
misunderstanding and unnecessary distress. Denial,
Anger, Bargaining, Depression, Acceptance.
• Dr. Wardons task (grieving process) – starts from
acceptance
• Don’t passing the buck – aalamin po natin kay doctor
• Rehabilitation to maximize – in palliative care, it
fully supports patient-envisioned end of life goals
such as mobility, independence and reduced burden
of care. That is why rehabilitation is essential
component as this will serve to maintain patient’s
physical capabilities to the maximum extent as
possible.
• Continuity of care and coordination between – it
is concerned with the quality of care over time. This
is the process in which the patient, the attending
physician, the caregiver and the family are
cooperatively involved in the ongoing care
management towards the shared goal which is
providing and maintaining quality of life of the
remaining days of the patient involved. And thus,
there should be proper coordination between the
services they provide.
• Terminal care – when someone is living with a
terminal illness, they are likely to receive treatment
and care which focuses on maintaining their
symptoms and maintaining quality life, and this part
of palliative care, the aim is to make the person or
the patient feel supported and give them a good
quality of life rather than cure the illness.
• Support in bereavement – we say that grief is the
normal emotional reaction to loss, but the course and
consequences of bereavement will vary for each
individual. That is why in palliative care it integrates
the psychological, spiritual and cultural aspect of
care and it also offers a support to help the carers,
Geria reviewer
the families on coping during the person’s illness and cardiopulmonary resuscitation (CPR) if a patient’s
in bereavement. According to Allan Wolfelt (2004), breathing stops or heart stops beating.
he suggests some coping mechanism – 2. Active Euthanasia is killing a patient by active means.
acknowledge and accept the reality of the death, For example, injecting a patient with a lethal dose of a
embrace the pain, receive ongoing support from drug → Aggressive Euthanasia
others 3. Passive Euthanasia letting patient die by withholding
• Education and research – there are evidence that artificial life support e.g., ventilator or feeding tube
experimental learning along with strategies that 4. Voluntary Euthanasia where person’s life is ended at
facilitates reflection on these experiences can their request in order to relieve them form suffering
improve our healthcare system as well as the
healthcare professionals in providing better palliative Elderly Abuse
care and their capacity to support and communicate • Many older people are victims of elder abuse. It is
with the patients and their families. This is the very the mistreatment of an older person, usually by a
reason why we need to continue educate ourselves caregiver. It can happen within the family. It can also
with training and updates, more so the very reason happen in assisted living facilities or nursing homes.
why research is important in our profession. We need • The mistreatment may be
to experiment; we need to find new solutions and − Physical, sexual, or emotional abuse
maybe there are still problems that still don’t have − Neglect or abandonment
solutions that will help us more with better palliative − Financial abuse - stealing of money or
care. belongings
• Possible signs of elder abuse include unexplained
Palliative – is comfort care Hospice – is comfort care bruises, burns, and injuries. There may also be bed
with or without curative without curative intent; sores and poor hygiene. The person may become
intent. patient has no longer withdrawn, agitated, and depressed. There may be a
curative options or has sudden change in the person's financial situation.
chosen not to pursue
treatment because the
side outweigh the benefits.
- Main setting of both is anywhere you call home. Team
includes doctors, nurses, social workers, chaplains,
dietitians.
Quality of life Comfort
Chronic illness Terminally ill
Broader concept More specific
Main setting Main setting
Main caregiver Main caregiver

Nurses’ Role in Palliative Care

• Direct care. nurses help patient adhere to their
medication schedules and protocols while still
maintaining a direct line of communication between
the patient and the attending physician, managing
equipment. Nurses help patient and their families
feel safe and comfortable.
• Advocate. nurses as an advocate meaning, the
nurse will work on behalf of the patients to maintain
quality of care and protect the patient's rights. They
will intervene when there is a care concern, and work
to resolve any patient care issues.
• Counselor. nurse as a counselor, nurses can also
be a counselor especially if she knows how to be an
active listener like having appropriate body language
such as eye contact and gesture to indicate
attentiveness and interest. Simple gesture of being
with the patient, listening and understanding their
concern is a big help already to the patient.
• Collaborative role. palliative nurses must be able to
communicate the information to both the patient and
family. It is within the nursing scope of practice to
thoroughly explain and educate patients and families
on symptoms and treatment through the end of life.

Issues and Trends in Palliative Care

1. DNR (do-not-resuscitate) usually written by a doctor
or per request by the patient. It instructs healthcare
provides or nurses NOT to provide or do

pg. 5 – SHANE SANTOS